Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study

PURPOSE

To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes.

METHODS

The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes.

RESULTS

SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status.

CONCLUSION

AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.

Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment

(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. (3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC_3,1 = 0.77), predominantly expected small-to-high correlations with construct variables (r = 0.21–0.59), good test–retest reliability (ICC_3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days; p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status. (4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI.

Construct Validity, Test-Retest Reliability, Sensitivity to Change, and Feasibility of the Patient-Specific Functional Scale in Acutely Hospitalized Older Patients With and Without Cognitive Impairment

BACKGROUND AND PURPOSE

The Patient-Specific Functional Scale (PSFS) as an individualized patient-reported outcome measure may allow to assess limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI).

METHODS

The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients-83.0 (6.4) years-with (Mini-Mental State Examination [MMSE] 18-23, n = 52) and without CI (MMSE ≥24, n = 68) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (rs) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects.

RESULTS

The PSFS showed fair to moderate correlations with all construct variables in patients with CI (rs = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (rs = |0.27 to 0.36|), but low for the SPPB and DEMMI (rs = -0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in both subgroups.

CONCLUSIONS

The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment.

Concurrent Validity, Test-Retest Reliability, and Sensitivity to Change of a Single Body-Fixed Sensor for Gait Analysis during Rollator-Assisted Walking in Acute Geriatric Patients

Body-fixed sensor (BFS) technology offers portable, low-cost and easy-to-use alternatives to laboratory-bound equipment for analyzing an individual's gait. Psychometric properties of single BFS systems for gait analysis in older adults who require a rollator for walking are, however, unknown. The study's aim was to evaluate the concurrent validity, test-retest-reliability, and sensitivity to change of a BFS (DynaPort MoveTest; McRoberts B.V., The Hague, The Netherlands) for measuring gait parameters during rollator-assisted walking. Fifty-eight acutely hospitalized older patients equipped with the BFS at the lower back completed a 10 m walkway using a rollator. Concurrent validity was assessed against the Mobility Lab (APDM Inc.; Portland, OR, USA), test-retest reliability over two trials within a 15 min period, and sensitivity to change in patients with improved, stable and worsened 4 m usual gait speed over hospital stay. Bland-Altman plots and intraclass correlation coefficients (ICC) for gait speed, cadence, step length, step time, and walk ratio indicate good to excellent agreement between the BFS and the Mobility Lab (ICC_2,1 = 0.87-0.99) and the repeated trials (ICC_2,1 = 0.83-0.92). Moderate to large standardized response means were observed in improved (gait speed, cadence, step length, walk ratio: 0.62-0.99) and worsened patients (gait speed, cadence, step time: -0.52 to -0.85), while those in stable patients were trivial to small (all gait parameters: -0.04-0.40). The BFS appears to be a valid, reliable and sensitive instrument for measuring spatio-temporal gait parameters during rollator-assisted walking in geriatric patients.